Modern Endo Course Booking Form

Course places are limited so reserve your place(s) today.

Select your preferred date and location

Friday 6th March - EDINBURGH
Friday 20th March - LONDON
Friday 24th April - BIRMINGHAM
Friday 8th May - NORWICH
Friday 5th June - EXETER
Friday 11th September - SOUTHAMPTON
Friday 18th September - LONDON

Booking details

Delegate Name:

GDC Number:

2nd Delegate Name (if applicable):

GDC Number (if applicable):

Schottlander Acc No (if known):

Practice Name:

Practice Address

Postcode

Daytime Telephone Number:

Email:

Do you have any special dietary requirements

We will confirm your course place by email and post. If you would like your confirmation details posted to another address, i.e. home, please enter your address details here:

Optional postal address if different from above

PAYMENT SECTION

Schottlander accepts all major credit and debit cards.

If you complete the payment section below we will process your payment within 48 hours (Monday to Friday) and confirm your place by email and post.

Card holders name

Card number (no spaces required)

Expiry date MM/YY

Card Security Code (CVC)

Please tick this box if you would prefer to make the payment over the telephone

We will contact you on the daytime telephone number you provided above

Modern Endodontics in a Day - Course Booking Form

PAYMENT SECTION